Mm Chapter 4. The Anesthesia Machine

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ASA Closed Claims Project database
most common single source of injury (39%

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The breathing circuit was the most common single source of injury (39%);

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ASA Closed Claims Project database

nearly all incidents were related

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to misconnects or disconnects

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All modern vaporizers are agent specific, capable of delivering a constant concentration of agent regardless of

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temperature changes or flow through the vaporizer.

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The major advantage of a piston ventilator is

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deliver accurate tidal volumes to patients with very poor lung compliance and to very small patients.

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Anesthesia workstations should have at least three disconnect alarms:

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low pressure,
low exhaled tidal volume,
and low exhaled carbon dioxide.

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Waste-gas scavengers dispose of gases that have been vented from the breathing circuit by
2X

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APL valve and ventilator spill valve.

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published standard specifications for anesthesia machines and their components.

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The American National Standards Institute and subsequently the ASTM (formerly the American Society for Testing and Materials,

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cylinder gases,
machines utilize a pressure regulator to reduce the cylinder gas pressure to

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45–47 psig1 before it enters the flow valve

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3 Causes of flowmeter malfunction include

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include dirt in the flow tube, vertical tube misalignment, and sticking or concealment of a float at the top of a tube.

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The oxygen flow valves are usually designed to deliver a minimum flow of ______ mL/min when the anesthesia machine is turned on.

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150

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safety feature of anesthesia machines is linkage of the nitrous oxide gas flow to the oxygen gas flow; this arrangement helps ensure a minimum oxygen concentration of __%

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21–25%

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One milliliter of liquid anesthetic is the equivalent of approximately ____ mL of anesthetic vapor

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200

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Modern Conventional Vaporizers are what type

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variable-bypass vaporizer.

Because some of the entering gas is never exposed to anesthetic liquid, this type of agent-specific vaporizer is also known as a variable-bypass vaporizer.

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"pumping effect" is more pronounced with

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low gas flows.

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Tec 6 Plus maintains a constant desflurane concentration over a wide range of fresh gas flow rates,
but ...

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it cannot automatically compensate for changes in elevation. Decreased ambient pressure (eg, high elevations) does not affect the concentration of agent delivered, but decreases the partial pressure of the agent. Thus, at high elevations, the anesthesiologist must manually increase the concentration control.

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Three types of oxygen analyzers are available:

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polarographic (Clark electrode), galvanic (fuel cell), and paramagnetic

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heat loss accounts for about only ____% of total intraoperative heat loss

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5–10

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Flow out of the lungs is determined primarily by

2x

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airway resistance and lung compliance

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Plateau pressure is the pressure measured during

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an inspiratory pause (a time of no gas flow), and mirrors static compliance.

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Peak inspiratory pressure is

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the highest circuit pressure generated during an inspiratory cycle, and provides an indication of dynamic compliance.

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10 causes for Increased PIP and PP

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Increased tidal volume

Decreased pulmonary compliance

Pulmonary edema

Trendelenburg position

Pleural effusion

Ascites

Abdominal packing

Peritoneal gas insufflation

Tension pneumothorax

Endobronchial intubation

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8 causes of Increased PIP and Unchanged PP

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Increased inspiratory gas flow rate

Increased airway resistance

Kinked endotracheal tube

Bronchospasm

Secretions

Foreign body aspiration

Airway compression

Endotracheal tube cuff herniation

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compliance for standard adult breathing circuits is about

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5 mL/cm H2O. Thus, if peak inspiratory pressure is 20 cm H2O, about 100 mL of set tidal volume is lost to expanding the circuit. For this reason breathing circuits for pediatric patients are designed to be much stiffer, with compliances as small as 1.5–2.5 mL/cm H2O.

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National Institute for Occupational Safety and Health (NIOSH) recommends limiting the room concentration

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25 ppm and halogenated agents to 2 ppm (0.5 ppm if nitrous oxide is also being used).

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The vacuum control valve on an active system should be adjusted to allow the evacuation of

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10–15 L of waste gas per minute.